http://www.hindawi.comThe latest articles from Hindawi Publishing Corporation© 2012, Hindawi Publishing Corporation. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/241703/Objectives. To investigate whether lifestyle-only intervention in obese children who maintain or lose a modest amount of weight redistributes parameters of body composition and reverses metabolic abnormalities. Study Design. Clinical, anthropometric, and metabolic parameters were assessed in 111 overweight or obese children (CA of 11.3 ± 2.8 years; 63 females and 48 males), during 8 months of lifestyle intervention. Patients maintained or lost weight (1–5%) (group A; n: 72) or gained weight (group B). Results. Group A patients presented with a decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<.005 and P<.05, resp.), BMI (P<.0001), z-score BMI (P<.0001), waist circumference (P<.0001), fat mass (P<.005), LDL-C (P<.05), Tg/HDL-C ratio (P<.05), fasting and postprandial insulin (P<.005), and HOMA (P<.005), while HDL-C (P<.05) and QUICKI increased (P<.005). Conversely, group B patients had an increase in BMI (P<.0001), waist circumference (P<.005), SBP (P<.005), and in QUICKI (P<.005), while fat mass (P<.05), fasting insulin (P<.05), and HOMA (P<.05) decreased. Lean mass, DBP, lipid concentrations, fasting and postprandial glucose, postprandial insulin, and ultrasensitive C-reactive protein (CRP) remained stable. Conclusions. Obese children who maintain or lose a modest amount of weight following lifestyle-only intervention tend to redistribute their body fat, decrease blood pressure and lipid levels, and to improve parameters of insulin sensitivity.Henry Marcano, Maricelia Fernández, Mariela Paoli, Mercedes Santomauro, Nolis Camacho, Rosanna Cichetti, Zarela Molina, Lenin Valeri, and Roberto LanesCopyright © 2011 Henry Marcano et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/817954/Background. It is well acknowledged that glucocorticoid (GC) replacement can unmask diabetes insipidus (DI) in subjects with hypopituitarism. Objective. To increase the awareness and monitoring for transient and symptomatic DI in children with partial hypopituitarism during periods in which increased GC needs are required. Methods/Case. A 2-month-old female infant with septo-optic dysplasia (SOD; on thyroid and maintenance GC replacement therapy at 8 mg/m2/day) developed transient DI during 2 separate episodes of stress (one hypothermia, one febrile) when stress dosing of GC (25 mg/m2/day) was instituted. Conclusion. Children not diagnosed with DI during initial evaluation for hypopituitarism may benefit from rescreening of serum sodium levels during acute periods of stress that demand “stress” GC dosing. This will permit treatment and/or increased vigilance for ensuing permanent DI.Mala Puri, Anita Azam, and Karen J. LoechnerCopyright © 2011 Mala Puri et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/417949/Objective. To assess the effect of combined diazoxide-metformin therapy in obese adolescents treated for craniopharyngioma. Design. A prospective open-label 6-month pilot treatment trial in 9 obese subjects with craniopharyngioma. Diazoxide (2 mg/kg divided b.i.d., maximum 200 mg/day) and metformin (1000 mg b.i.d.). Whole body insulin sensitivity index (WBISI) and area-under-the-curve insulin (AUCins) were calculated. Results. Seven subjects completed: 4M/3F, mean ± SD age 15.4±2.9 years, weight 99.7±26.3 kg, BMI 35.5±5.6 kg/m2, and BMI SDS 2.3±0.3. Two were withdrawn due to vomiting and peripheral edema. Of participants completing the study, the mean ± SD weight gain, BMI, and BMI SDS during the 6 months were reduced compared to the 6 months prestudy (+1.2±5.9 versus +9.5±2.7 kg, P=.004; −0.3±2.3 versus +2.2±1.5 kg/m2, P=.04; −0.04±0.15 versus +0.11±0.08, P=.021, resp.). AUCins correlated with weight loss (r=0.82, P=.02) and BMI decrease (r=0.96, P=.009). Conclusion. Combined diazoxide-metformin therapy was associated with reduced weight gain in patients with hypothalamic obesity. AUCins at study commencement predicted effectiveness of the treatment.Jill K. Hamilton, Louise S. Conwell, Catriona Syme, Alexandra Ahmet, Allison Jeffery, and Denis DanemanCopyright © 2011 Jill K. Hamilton et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/138903/Graves' disease is less common in prepubertal than pubertal children, and initial presentation with thyroid storm is rare. We report an 11-year-old prepubertal Hispanic girl who presented with a one-day history of respiratory distress, fever, and dysphagia. She had exophthalmos, a diffuse bilateral goiter and was agitated, tachycardic, and hypertensive. Nasal swab was positive for respiratory syncytial virus (RSV). She was diagnosed with thyroid storm and admitted to the pediatric intensive care unit. While infection is a known precipitant of thyroid storm and RSV is a common pediatric infection, to the best of our knowledge, this is the first reported case of RSV infection apparently precipitating thyroid storm in a prepubertal child.Ivy R. Aslan, Elizabeth A. Baca, R. William Charlton, and Stephen M. RosenthalCopyright © 2011 Ivy R. Aslan et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/847603/Hereditary medullary thyroid cancer is an aggressive cancer for which there is no standard effective systemic therapy, but which can be prevented through genetic screening and prophylactic thyroidectomy. Although this cancer accounts for roughly 17% of all pediatric thyroid cancers, a significant percentage of affected families do not “accept” screening, while many gene carriers delay or refuse prophylactic thyroid surgery for their children. Current genetic screening practices in medullary thyroid cancer are inadequate; more than 50% of index patients with hereditary medullary thyroid cancer present with a thyroid mass; up to 75% have distant metastasis. These proposed pediatric ethics guidelines focus on two ethical issues that affect at-risk children: (1) how do we identify at-risk children whose RET-positive relative refuses to disclose that they carry the mutation? (2) How do we protect RET-positive children whose parents refuse prophylactic thyroidectomy?M. Sara Rosenthal and Douglas S. DiekemaCopyright © 2011 M. Sara Rosenthal and Douglas S. Diekema. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/398639/Methods. This prospective US multicenter trial of leuprolide acetate 1-month depot (7.5–15 mg) for central precocious puberty utilized an open-label treatment period, long-term follow-up, and adult callback. Forty-nine females <9 years old with Tanner breast stage ≥2 before 8 years and 6 males <10 years old with Tanner genital stage ≥2 before 9 years with stimulated LH ≥10 IU/L and bone age advance ≥1 year were enrolled. Results. Subjects were treated for 3.9 ± 2.0 years. Mean peak GnRH-stimulated LH and FSH were prepubertal after the first dose and remained suppressed throughout treatment. During treatment, mean estradiol decreased to the limit of detection and mean testosterone decreased but remained above prepubertal norms. During posttreatment follow-up (3.5 ± 2.2 years), all patients achieved a pubertal hormonal response within 1 year and menses were reported in all females ≥12 years old. No impairment of reproductive function was observed at adulthood (mean age: 24.8 years).E. Kirk Neely, Peter A. Lee, Clifford A. Bloch, Lois Larsen, Di Yang, Cynthia Mattia-Goldberg, and Kristof ChwaliszCopyright © 2010 E. Kirk Neely et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2011/184502/Premature activation of the hypothalamic-pituitary-gonadal (HPG) axis manifests as gonadotropin-dependent precocious puberty. The mechanisms behind HPG activation are complex and a clear etiology for early activation is often not elucidated. Though collectively uncommon, the neoplastic and developmental causes of gonadotropin-dependent precocious puberty are very important to consider, as a delay in diagnosis may lead to adverse patient outcomes. The intent of the current paper is to review the neoplastic and developmental causes of gonadotropin-dependent precocious puberty. We discuss the common CNS lesions and human chorionic gonadotropin-secreting tumors that cause sexual precocity, review the relationship between therapeutic radiation and gonadotropin-dependent precocious puberty, and finally, provide an overview of the therapies available for height preservation in this unique patient population.Matthew D. Stephen, Peter E. Zage, and Steven G. WaguespackCopyright © 2011 Matthew D. Stephen et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/358358/Paul HofmanCopyright © 2010 Paul Hofman. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/107252/Children raised in orphanages frequently experience growth suppression due to multiple risk factors. Placing such children in more nurturing environments through adoption leads to significant catch-up growth (CUG), the determinants of which are not entirely understood. The goal of this study was to perform an auxological evaluation and examine the degree and correlates of CUG in international adoptees. Children adopted from Eastern Europe, (n=148, 71 males), 7 to 59 months of age, were recruited within 3 weeks of their arrival to the US. At baseline, mean height SDS was -1.2±1.1 and 22% were <−2 SDS for height. IGF-1 and/or IGFBP-3 levels <−2 SDS were present in 32%. CUG, defined as a gain of >+0.5 in height SDS, was seen in 62% of adoptees at 6 months after adoption; 7% of children remained <−2 SDS for height (two had growth hormone deficiency). Growth factors improved in the majority of children. Younger age, greater degree of initial growth failure, and higher caloric intake were significantly associated with improved linear growth in multiple regression models. In summary, most adoptees demonstrate excellent CUG within six months after adoption. If growth failure persists after 6 months of appropriate caloric intake, nutrition-independent causes should be considered.Bradley S. Miller, Maria G. Kroupina, Patrick Mason, Sandra L. Iverson, Christine Narad, John H. Himes, Dana E. Johnson, and Anna PetrykCopyright © 2010 Bradley S. Miller et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/546854/Objectives. To evaluate, in children with Silver-Russell Syndrome, the response to the IGF-I and IGFBP-3 generation test and compare results to the growth response after 6 months of rhGH. Methods. Eight children (6 males), with a mean age of 5.71±2.48 years and height SDS of −3.88±1.28 received rhGH for 6 months. IGF-I and IGFBP-3 were analyzed before and after 4 doses of rhGH. Results. The mean growth velocity (GV) before treatment was 5.28±1.9 cm/year. GV increased after rhGH in five children to a mean GV of 10.3±3.64 cm/year. Six children had normal basal IGF-I levels and two low levels. After 4 doses of rhGH, the IGF-I levels were normal in seven. There was no correlation between the growth response and the IGF-I generation test. Conclusions. Children with SRS have normal IGF-I generation test. There is no correlation between the generation test and the growth velocity after 6 months of rhGH.Izabel C. R. Beserra, Márcia G. Ribeiro, Paulo F. Collett-Solberg, Mário Vaisman, and Marília M. GuimarãesCopyright © 2010 Izabel C. R. Beserra et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/493258/Lack of insulin results in a catabolic state in subjects with insulin-dependent diabetes mellitus which is reversed by insulin treatment. Amino acid supply, especially branched chain amino acids such as leucine, enhances protein synthesis in both animal and human studies. This small study was undertaken to assess the acute effect of supplemental leucine on protein metabolism in adolescents with type 1 diabetes. L-[1-13C] Leucine was used to assess whole-body protein metabolism in six adolescent females (16–18 yrs) with type 1 diabetes during consumption of a basal diet (containing 58 μmoles leucine/kg/h) and the basal diet with supplemental leucine (232 μmoles leucine/kg/h). Net leucine balance was significantly higher with supplemental leucine (56.33 ± 12.13 μmoles leucine/kg body weight/hr) than with the basal diet (−11.7±−5.91, P<.001) due to reduced protein degradation (49.54 ± 18.80 μmoles leucine/kg body weight/hr) compared to the basal diet (109±13.05, P<.001).Vardhini Desikan, Izolda Mileva, Jeremy Garlick, Andrew H. Lane, Thomas A. Wilson, and Margaret A. McNurlanCopyright © 2010 Vardhini Desikan et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/316170/This study aimed to determine the prevalence of metabolic syndrome (MeS) and its individual components in Jordanian children and adolescents aged 7–18 years and determine the factors that are associated with clustering of metabolic abnormalities. MeS was defined using the International Diabetes Federation (IDF) definition. The prevalence of MeS was estimated from 512 subjects who had complete information on all MeS components. The prevalence of MeS according to IDF criteria was 1.4% in subjects aged between 10 and 15.9 years and 3.6% in subjects aged between 16 and 18 years. When categorized according to body mass index (BMI), the prevalence of the MeS was 15.1% in obese subjects, compared to 0.3% in subjects with normal BMI, and 3.0% in overweight subjects. In conclusion, our results indicate that although the prevalence of MeS is low in Jordanian children and adolescents, a large proportion of them had one or two metabolic abnormalities.Yousef Khader, Anwar Batieha, Hashim Jaddou, Mohammed El-Khateeb, and Kamel AjlouniCopyright © 2010 Yousef Khader et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/740629/Objective. The aim was to determine efficacy and safety of a surgical method to reduce adult height in extremely tall adolescents. Methods. Data for all girls (n=12) and boys (n=9) in our center subjected to bilateral percutaneous epiphysiodesis around the knee who had reached final height were included. Final height predictions were based on hand and wrist X-rays before surgery. Results. When compared to prediction, adult height was reduced by 4.1±0.7 cm in treated girls (P<.001) and 6.4±0.7 cm in treated boys (P<.001) corresponding to a 33.6±3.4% and 33.6±4.2% reduction of remaining growth, respectively. Besides mild to moderate postoperative pain reported in 9 operated individuals, no other side effects were reported. Postoperative X-rays confirmed growth plate closure and absence of leg angulations. Conclusions. Bilateral epiphysiodesis is an effective and safe method to reduce adult height in extremely tall girls and boys.Emelie Benyi, Maria Berner, Inger Bjernekull, Anders Boman, Dionisios Chrysis, Ola Nilsson, Anne Waehre, Henrik Wehtje, and Lars SävendahlCopyright © 2010 Emelie Benyi et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/410502/Objective. This study describes the magnitude and characteristics of nutritional rickets and associated risk factors among children in Qatar. Subjects. A consecutive sample of 730 healthy subjects who visited the primay health care clinics were approached and 540 (73.9%) subjects gave consent. Mehods. Nutritional rickets diagnosis was based on clinical radiologic and biochemical parameters and normalization of alkaline phosphatase level after 6 weeks course of daily vitamin D therapy. Results. The study revealed that 23.9% of the studied children had nutritional rickets. The mean ± SD age of those with rickets (3.76 years ± 1.51) was slightly higher than those without rickets (3.57 years ± 1.45). Family history of vitamin D deficiency (44.2%; P = .001) and diabetes mellitus (53.5%; P = .002) were significantly higher in rachitic children than in nonrachitic children. The children with rickets spent a significantly shorter average duration (26.86 minutes ± 19.94) under the sun than those without rickets (30.59 minutes ± 15.72; P<.001). A significantly larger proportion of rachitic children was afflicted with vitamin D deficiency (75.2% versus 62.2%; P<.001), secondary hypothyroidism (100% versus 7.5%; P = .009) and muscular weakness (56.6% versus 26.3%; P<.001). Conclusion. The most important risk factors were low vitamin D and calcium intakes, lack of exposure to sunlight, prolonged breast feeding without supplementation of vitamin D.Abdulbari Bener and Georg F. HoffmannCopyright © 2010 Abdulbari Bener and Georg F. Hoffmann. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/919707/The Gender Medicine Team (GMT), comprised of members with expertise in endocrinology, ethics, genetics, gynecology, pediatric surgery, psychology, and urology, at Texas Children's Hospital and Baylor College of Medicine formed a task force to formulate a consensus statement on practice guidelines for managing disorders of sexual differentiation (DSD) and for making sex assignments. The GMT task force reviewed published evidence and incorporated findings from clinical experience. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence presented in the literature for establishing evidence-based guidelines. The task force presents a consensus statement regarding specific diagnostic and therapeutic issues in the management of individuals who present with DSD. The consensus statement includes recommendations for (1) laboratory workup, (2) acute management, (3) sex assignment in an ethical framework that includes education and involvement of the parents, and (4) surgical management.Ganka Douglas, Marni E. Axelrad, Mary L. Brandt, Elizabeth Crabtree, Jennifer E. Dietrich, Shannon French, Sheila Gunn, Lefkothea Karaviti, Monica E. Lopez, Charles G. Macias, Laurence B. McCullough, Deepa Suresh, and V. Reid SuttonCopyright © 2010 Ganka Douglas et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/494656/To assess gender-, pubertal-, age-related differences in change from baseline height standard deviation score (ΔHSDS), data from 5,797 growth hormone (GH) naïve pediatric patients (<18 years) with growth hormone deficiency (GHD), multiple pituitary hormone deficiency (MPHD), Turner syndrome (TS), small for gestational age (SGA), Noonan syndrome (NS), and idiopathic short stature (ISS) were obtained from the ANSWER (American Norditropin Studies: Web-enabled Research) Program registry. For patients with SGA, ΔHSDS at year 1 was significantly greater for males versus females (P=.016), but no other gender differences were observed. For patients with GHD, ΔHSDS was greater in prepubertal than in pubertal patients. Younger patients for both genders (<11 years for boys; <10 years for girls) showed a greater ΔHSDS (P<.05 for GHD, MPHD, and ISS). Overall, positive ΔHSDSs were observed in all patients, with greater growth responses in younger prepubertal children, emphasizing the importance of starting GH treatment early.Judith Ross, Peter A. Lee, Robert Gut, and John GermakCopyright © 2010 Judith Ross et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/867471/Transdermal testosterone gels are used in the treatment of hypoandrogenism of males. Virilization due to exposure to testosterone gels has been reported in children resulting in a US Food and Drug Administration (FDA) warning about secondary exposure to these products. At present, we are unaware of prenatal virilization associated with unintentional testosterone gel exposure. We report prenatal virilization in a female infant due to secondary maternal exposure to the father's testosterone gel. We also describe postnatal virilization of the child's twin sister.Anisha Patel and Scott A. RivkeesCopyright © 2010 Anisha Patel and Scott A. Rivkees. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/432060/Polyostotic fibrous dysplasia (FD) associated to McCune-Albright Syndrome (MAS) often leads to fractures, deformities, and bone pain resulting in bad quality of life. Parenteral bisphosphonates have been used in children and adolescents to improve these symptoms with few adverse effects. We evaluated the response to oral Alendronate in a girl with severe MAS FD and observed improved quality of life with reduction of bone pain.Ana Luiza Andrade Aragão and Ivani Novato SilvaCopyright © 2010 Ana Luiza Andrade Aragão and Ivani Novato Silva. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/891571/Our purpose was to determine pediatric endocrinologists' knowledge, attitudes, beliefs, and practices (KABPs) regarding recombinant human growth hormone (rhGH) treatment, examine care-related attitude consensus or discordance, and identify evidence-based practice gaps. We developed a survey for National Cooperative Growth Study (NCGS) investigators (N=711) to elicit their KABPs regarding GH stimulation testing as a diagnostic tool, IGF-1 monitoring for safety and dosing guidance, and pubertal dosing. Responses were compared with NCGS data from the last 20 years. Comparison between survey responses and NCGS data revealed potential discrepancies between expressed opinions and actual practice. In conclusion, this KABP survey, combined with NCGS data, suggests changes over time in diagnostic and rhGH-related therapeutic practices. Variability and inconsistency exist between the survey responses and practice trends over time as reflected in the NCGS database. Further study is necessary to provide evidence to guide rhGH treatment decisions.Bradley S. Miller, Dorothy I. Shulman, Alicia Shillington, Qing Harshaw, Darrell M. Wilson, David Schwartz, Michael Kappy, Bert Bakker, and David WyattCopyright © 2010 Bradley S. Miller et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/681510/Objective. To assess the impact of exercise consultation on physical activity (PA) levels, anthropometric measures, and metabolic markers in obese adolescents. Methods. Obese adolescents (14–18 years) were randomized to either an exercise consultation (intervention group) or to review “Canada's Physical Activity Guide for Youth” (control group). Outcomes, including accelerometry, anthropometrics, blood pressure, stage of exercise behavior change, fasting glucose, insulin, and lipids, were measured at baseline and 3 months later. Results. Thirty adolescents (mean BMI=36.1 kg/m2; SD=6.9) completed the study. At follow-up, the intervention group had significantly greater PA compared with controls (P<.05). Similarly, the intervention group weighed an average 2.6 kg less than the control group (P<.05), with a mean BMI z-score of 2.15 compared to 2.21 for controls (P=.054). No other differences were noted. Conclusion. Exercise consultation may be a simple approach to increase PA levels, reduce weight, and lower BMI in obese adolescents.M. Henderson, D. Daneman, C. Huot, J. McGrath, M. Lambert, J. Hux, G. L. Booth, and A. HanleyCopyright © 2010 M. Henderson et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/536957/Our objective was to determine the impact of telemedicine (TM) interventions on the management of type 1 diabetes (T1DM) in youth. We performed a systematic review of randomized trials that evaluated TM interventions involving transmission of blood glucose data followed by unsolicited scheduled clinician feedback. We found no apparent effect of the TM interventions on hemoglobin A1c (HbA1c), severe hypoglycemia, or diabetic ketoacidosis. The limited data available on patient satisfaction, quality of life, and cost also suggested no differences between groups. It is unlikely that TM interventions, as performed in the assessed studies, had a substantial effect on glycemic control or acute complications. However, it remains possible that there are other benefits of TM not adequately reported, that newer TM strategies may be more effective and that interventions may benefit subgroups of youth, such as those with the poor glycemic control, adolescents, or those living in remote areas.Rayzel M. Shulman, Clodagh S. O'Gorman, and Mark R. PalmertCopyright © 2010 Rayzel M. Shulman et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/724696/Background. Excess adiposity and premature adrenarche (PA) are risk factors for the development of polycystic ovary syndrome (PCOS). Methods. Girls with slowly progressive precocious breast development, who were overweight and had PA (SPPOPA, 6.2–8.2 years, n=5), overweight PA (6.6–10.8 years, n=7), and overweight premenarcheal controls (OW-PUB, 10.6–12.8 years, n=8) underwent hormonal sleep testing and GnRH agonist (GnRHag) and ACTH tests. Results. Despite an insignificant sleep-related increase in LH and prepubertal baseline hormone levels, SPPOPA peak LH and estradiol responses to GnRHag were intermediate between those of PA and OW-PUB, the LH being significantly different from both. Conclusions. GnRHag tests indicate that SPPOPA is a slowly progressive form of true puberty with blunted LH dynamics. These results argue against the prepubertal hyperandrogenism of excess adiposity or PA enhancing LH secretion or causing ovarian hyperandrogenism prior to menarche. Excess adiposity may contribute to both the early onset and slow progression of puberty.Brian Bordini, Elizabeth Littlejohn, and Robert L. RosenfieldCopyright © 2010 Brian Bordini et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/717303/We describe acute myopathy following I-131 treatment for hyperthyroidism due to Graves Disease (GD) in an adolescent. A 15 year-old diagnosed with GD required treatment with radioactive iodine (I-131) therapy. Six weeks post I-131, he developed generalized muscle cramps. The CK was 19.800 U/L, the total thyroxine was 2.3 mcg/dL (29.6 nmol/L SI) and the estimated free thyroxine (EFT) was 0.5 ng/dL (6.4 pmol/L SI). The ALT was 112 U/L and AST was 364 U/L (normal <35 U/L). The muscle cramps and CK elevation normalized five months after initiation of thyroid replacement therapy. This observation shows that acute myopathy can rarely occur in pediatric patients with GD following treatment with I-131.Valeria C. Benavides and Scott A. RivkeesCopyright © 2010 Valeria C. Benavides and Scott A. Rivkees. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/159402/There is increasing use of antipsychotic drugs in pediatric and psychiatry practice for a wide range of behavioral and affective disorders. These drugs have prominent side effects of interest to pediatric endocrinologists, including weight gain and associated metabolic risk factors and hyperprolactinemia. The drugs block dopamine action, thus disinhibiting prolactin secretion. Hyperprolactinemia is especially prominent with first-generation antipsychotics such as haloperidol and the second-generation drugs, most commonly risperidone, with some patients developing gynecomastia or galactorrhea or, as a result of prolactin inhibition of gonadotropin releasing hormone from the hypothalamus, amenorrhea. With concern about the long-term effects of antipsychotics on bone mass and pituitary tumor formation, it is prudent to monitor serum prolactin levels in antipsychotic drug-treated pediatric patients and consider treatment with an agent less likely to induce hyperprolactinemia.Arlan L. RosenbloomCopyright © 2010 Arlan L. Rosenbloom. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/846070/Objective. To evaluate the relationship between adiponectin and physical activity (PA) in minority female youth. Methods. Plasma adiponectin was measured in 39 females (mean age 9.2±0.9 years; 30 Latina, 9 African-American; 56% overweight). PA was assessed by accelerometry. Mean minutes per day spent in daily PA (DPA) (≥3 metabolic equivalents (METs)), moderate PA (MPA)(4–7 METs), vigorous PA (VPA)(≥7 METs), and moderate-to-vigorous PA (MVPA)(≥4 METs) were calculated. The association between adiponectin and PA, controlling for age, fat weight, lean weight, and insulin sensitivity (SI) was analyzed using linear regression. Results. Adiponectin correlated with fat weight (r=-0.43, P<.01) and SI (r=0.52, P<.01). Minutes spent in DPA (β=-0.40, P=.02), MPA (β=-0.36, P=.04), or MVPA (β=-0.37, P=.03) were predictors of adiponectin in the adjusted model. Conclusions. Higher PA levels were related to lower adiponectin levels. Potential mechanisms include upregulation of adiponectin receptors or an increase in high-molecular weight adiponectin with increasing PA.B. Adar Emken, Joyce Richey, Britni Belcher, Ya-Wen Hsu, and Donna Spruijt-MetzCopyright © 2010 B. Adar Emken et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/749239/Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 μg/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.Angela H. Santiago and Susan RatzanCopyright © 2010 Angela H. Santiago and Susan Ratzan. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/964525/Background. Adrenal insufficiency is a life-threatening event. It is recommended that patients with known adrenal insufficiency and their families receive careful and repeated education on sick-day glucocorticoid management. We hypothesized that the electronic medical record (EMR) can be used to improve patient education through automated provider notification. Methods. We established an automated electronic alert in the EMR that triggered in the outpatient endocrine clinic. The alert asked if stress dose education was reviewed at the visit. The response to this alert was evaluated between July 15, 2009 and February 19, 2010. Results. 128 unique patients had visits both prior to and following the implementation of the EMR alert. The alert was acknowledged in 58 unique patient visits. After the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to implementation of the alert, 48/128 (38%) of the patient encounters showed written documentation of stress dose review. Conclusion. This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids. Whether this translates into better outcomes for patients remains to be seen.Bahareh Schweiger, Philip Zeitler, Scott Eppley, Marguerite Swietlik, and Jennifer BarkerCopyright © 2010 Bahareh Schweiger et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/658267/715 days after potential problems related to PTU use in children were presented in a debate in front of the Lawson Wilkins Pediatric Endocrine Society (LWPES), the US Food and Drug Administration issued a “black-box” warning about the hepatotoxicity risk of the antithyroid drug propylthiouracil (PTU). This safety advisory followed the collective actions of academic societies, medical publishers, the National Institutes of Health, and the FDA. Considering that surgery and radioactive iodine are the legitimate treatment options for Grave Disease (GD), and are now the preferred alternative therapy in individuals who developed toxic reactions to MMI, the use of PTU should now be limited to exceptional circumstances and pregnancy. Long-term PTU therapy, especially in children, is not justifiable. The current advisory comes 63 years after the introduction of PTU for clinical use in 1947.Scott A. RivkeesCopyright © 2010 Scott A. Rivkees. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/652013/Objective. To characterize the pediatric endocrinologists' evaluation and followup of short-statured patients. Study Design. Observational study of 21,548 short-statured children (April 1996 to December 1999). Baseline demographics, laboratory testing, height standard deviation score (SDS), target height, and height relative to target height were analyzed at initial and return visits with the specialist. Patients were scheduled for at least one return visit and no recombinant human growth hormone therapy was administered. Results. Mean patient age was 8.6 years with a mean height SDS of −2.1. Patients were predominantly male (69%), prepubertal (73%), and white (76%). Few screening tests were obtained during initial evaluation. Nearly 40% of children did not return for their second scheduled visit. The follow-up rate was unrelated to demographics or degree of short stature. Conclusions. Low return rates limit specialists' ability to monitor growth or obtain laboratory testing over time. Further studies are needed to determine which tests should be obtained at the initial clinic visit as well as the basis for the low return rate in this group of children.David Wyatt, Katrina L. Parker, Stephen F. Kemp, Jane Chiang, and D. Aaron DavisCopyright © 2010 David Wyatt et al. All rights reserved.http://www.hindawi.com/journals/ijpe/2010/161285/Despite the advent of sensitive and specific serologic testing, routine screening for celiac disease (CD) in diabetic populations may not be universal practice, and many clinicians struggle to find the optimal approach to managing CD in pediatric Type 1 diabetes (T1D) patients. While some clinicians advocate screening for CD in all patients with T1D, others are unsure whether this is warranted. The diagnosis of patients who present with symptomatic CD, including malabsorption and obvious pathology upon biopsy, remains straightforward, with improvements noted on a gluten-free diet. Many patients identified by screening, however, tend to be asymptomatic. Evidence is inconclusive as to whether the benefits of screening and potentially treating asymptomatic individuals outweigh the harms of managing a population already burdened with a serious illness. This review focuses on current knowledge of CD in children and youth with T1D, highlighting important elements of the disease's pathophysiology, epidemiology, clinical presentation, and diagnostic challenges.Shama Sud, Margaret Marcon, Esther Assor, Mark R. Palmert, Denis Daneman, and Farid H. MahmudCopyright © 2010 Shama Sud et al. All rights reserved.